Trump is trying to destroy universities - Ashish Jha, Dean of Public Health at Brown University
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The problem with RFK Jr. is that his strategy is not based on evidence in science and data. If I had to go back over again, I probably would not have made the same decision. I think this administration has done an extraordinarily good job at helping China advance its agenda. It is hard to argue against the fact that pharmaceutical industry's products are things we all

love and rely on. That help us. That help us. Right now the politics are such that if you speak up against the Trump administration as a Republican, you will face a primary challenge. And if you lose that primary challenge, you're going to be out of a job. So you're going to have larger and larger outbreaks in a lot of places. And as you and I both know, that will mean you'll have kids who get very sick, kids with encephalitis, and unfortunately kids who are going to die.

Hello, welcome to a special edition of the BMJ podcast. I'm delighted to be joined by Ashish Jha. Ashish is Professor and Dean of Public Health at Brown University in the USA. And he was also Biden's COVID advisor.

Kamran, thanks so much for having me here. I'm excited to spend some time talking to you. Well, we're looking forward to it. And there's lots to talk about. There is a lot to talk about. A lot going on in the US. Really? Tell us about it. We did have an election. Things have changed, actually quite dramatically. It's been a very tumultuous couple of months. I'm happy to get into all of it, but it is...

Really an unprecedented time, both for the health sector, public health and medicine, and then for the whole scientific enterprise of the United States. Yeah. Really, I think, substantial threats and attacks on all of those sectors that I'm very worried is going to leave America much worse off. Mm-hmm.

The question is, where do we begin with this? I think let's begin by saying a lot of this was signaled. And I think people, if you read what is Project 2025, you know, in their agenda, they're

And people thought, well, probably he doesn't want to do all of that, is he? But he seems to be following that agenda pretty tightly. Yeah, this always surprises me. The fact that people are surprised is surprising. He absolutely signaled a lot of this. There has been a consistent theme where people think, well, surely he can't mean all this. And if he does, surely somebody will step up and stop him. Mm-hmm.

And right now, there really feels like there are very few guardrails inside the U.S. The courts are slowing him down. Congress right now does not seem to have much in the way of energy to do much to stop some of the actions coming out of the Trump administration.

And I agree with you, Kamran, all of this was signaled. None of this should be surprising. Yeah. I mean, a big part of, well, one of the elements of this, as largely espoused by RFK Jr., is make America healthy again. The sentiment is a very good one. Absolutely. But do you believe it?

Well, look, first of all, we all agree that there are serious problems with chronic disease, with our food industry in the U.S. Obesity, obviously, America's number one in the world on obesity, with about 70 to 75 percent of adults being overweight or obese. So we have a huge problem. That is, I think, neither some, you know, that's not an extraordinary diagnosis to make. The question is, what do we do about it?

And the general strategy and thinking that RFK Jr. brings to that, to vaccines, really comes out of, I think, a very naive notion of

of modern medicine. He sort of is very anti-modern medicine, believes that somehow there was a glorious period in our history, maybe in the 1920s or 30s, where everybody was healthy, everybody lived long lives. And of course, that's not true. Like the data suggests,

It's a kind of romanticized, nostalgic view of the past. It is. And it is a view that really believes that we have to get back to nature and that natural things are good and man-made things like pharmaceuticals and vaccines are toxic.

But actually, just holding out, if you say, you know, there's a problem with chronic disease, a problem with obesity, getting back to nature is good. Perhaps we do need a firmer hand with pharma and other industries. And you think, well, some of that isn't

Doesn't sound unreasonable. Correct. But it's the means of getting there that's the problem. It's the means. So first of all, there are problems with the pharmaceutical industry. The food industry undoubtedly has spent 50 years. I describe it as the U.S. food industry has spent 50 years hacking our brains, figuring out how to make food more and more irresistible, higher calorie, higher fat content. These are real problems. The question is, how do you begin to address it?

and what is your guidepost? And for me, it's gotta be evidence. It's gotta be data-driven. So you've gotta look at, if you wanna ban quote unquote chemicals, which chemicals? Well, it should be based on evidence, not based on, I think this is unnatural. I don't know what that means. What is natural? What is unnatural? So the problem with RFK Jr. is that his strategy is not based on evidence and science and data.

And I guess I am old fashioned in believing that the progress humanity has made over the last hundred years is because we have relied on evidence, science and data. And when we do, we make progress. And when we don't, we get ourselves into trouble. This is not a pro or anti-industry stance. It's what's the path you're going to take to make better decisions? Yeah. And as you say, a lot of it doesn't seem to be evidence based. When you look back at the hearings that RFK held,

Junior went through. I mean, he quoted papers, but as you and I know, quoting one paper is not science. Now, well, this is something that as a clinician, I know this is something you as both a scientist and an editor of, you know,

one of the world's premier medical journal understands is that on any important question there is rarely one paper that you can cite that answers it that there is a body of evidence and that the job when i think about myself clinically making a clinical decision i think what is a body of evidence and i put all of it together obviously higher quality evidence gets more weight than lower quality evidence and then i try to come to an answer a decision

What he does is he begins with a decision, like vaccines are bad or that cod liver oil is good treatment for measles. And then says, can I find any evidence? Well, sure. You can find at least one study out there. So for instance, there's actually quite a good study published in the BMJ. No. Yes. On cod liver oil and measles from 1932. And

And it's quite well done. And one could imagine that in 1932, in the height of the Great Depression, cod liver oil could have been quite useful for treating measles. But that is not where we are today. And he would argue, well, here's a study from BMJ. I'm like, well, 1932. Like the world has changed. Yeah, yeah. We've got treatments. I get that. And also, it...

What's happened is, I mean, you talk about evidence and I fully agree with you. It's almost as if evidence no longer matters. Science no longer matters. If we look at what's happening in the way that federal research and science seems to be dismantled.

It's as if science is bad and experts are bad. I think, you know, some of the politicians have said that as well. And that must be a very difficult position for somebody like you in your role. Well, so I think some of this stems from the pandemic.

There is obviously a lot of revisionism about the pandemic. And obviously, the experts in the pandemic didn't get everything right. And there were issues and mistakes in the way that the pandemic was handled that I'm happy to talk about. And I made mistakes in the pandemic.

But what has happened is that people have used those mistakes and those missteps to cast sort of doubt on the entire scientific enterprise and to argue that the entire scientific enterprise is corrupt or ineffective or, you know, all of those things. And then it is an attempt to sort of dismantle the broader scientific enterprise while still saying that.

We want to get back to high quality science. Right. All of us think that the scientific enterprise needed to be improved, that all of us believe that there were too many mediocre studies being funded by the NIH. Yeah. But the way to improve that is to improve the peer review process, to improve the systems we have or but but not to have.

20-year-old Doge employees going in and deciding which grants to cut off and which grants not to. That process will not get us to a better place. No, and it just all seems very cynical and there's an agenda here, isn't there? It's cutting costs and sort of it's curtailing people. It's clipping people's wings and saying, you know, you haven't delivered the recommendations that we agreed with and now we're going to

make you pay for that. Because if you look back at the pandemic, a lot of the people, you were Biden's COVID advisor, a number of the people who were very critical of the COVID response at the time, of the response to the US and the UK and elsewhere, are now in very prominent positions and they've always been very vocal about their view in terms of how most governments manage the pandemic. But now they're in a position of power and

And the revisionism is in their hands now. Exactly. Exactly. Look, what's interesting to me when I look at almost everybody who's been chosen to go into leadership roles, they're all very different from each other. They seem to have one unifying theme. They were all COVID skeptics. They were all people who downplayed the importance of COVID, downplayed vaccines. I mean, the ultimate irony here, Kamran, is from a U.S. point of view,

Donald Trump ran the most successful vaccine creation program in the history of the United States, Operation Warp Speed, and relied heavily on the National Institutes for Health. I mean, it was an incredible success story. And instead of, you know, instead of kind of glomming onto that and instead of celebrating that,

His senior leadership seems to be dismantling all of it in some ways, disavowing that progress. It's very odd and disturbing. But yes, at this moment, I think there is a real questioning of the value of scientific expertise. And we have a lot of work to do to get that back.

I'm not sure we're going to get it back with this administration, but much more important than that, we've got to get it back with the American people. Yeah. I mean, one of the problems with damaging science in the way that's being done now and the impact it's having in the U.S. and abroad is that it takes a very long time to build up that kind of system, the resources.

the person power and the systems to deliver, which was always thought of, the number one research enterprise in the whole world. But once you've dismantled it, it takes a long time getting back to where you were. Yes. And I would say two things about this. One is the negative effects of this dismantling is not going to be obvious for a while. If you stop funding basic science research,

Nobody will, except for the researchers, nobody will notice. It's just that in 10 years or 20 years, there are going to be really important innovations that'll never happen.

So that is one part of the strategy is to go after things for which the political consequences are not apparent in the short run. Yeah. Are they going to survive the political cycle? But people aren't surviving in Africa. The people who can't get their HIV prevention. Right. But the political cost to that of to Donald Trump is very, very low. Yeah. Right. And then there's even denialism that that's even happening. Yeah.

But the second part is you're absolutely right. What we're doing is sending a very strong signal to a whole generation of scientists that this is not the field for you, that NIH is not a reliable funder, the United States is not a reliable funder. Some of those people will go and work in pharma and elsewhere. So you're going to lose a generation of scientists to the private sector.

A lot of some of those people will go abroad and maybe that's good for other countries. But a lot of those people will just turn away from the scientific world and go, you know, go to law school or go to business. Yeah.

That is not recovery. I mean, like, we're going to have a whole generation of lost scientists if we don't, by the way, stop this. It's not... I don't think this is fait accompli. I don't think we're at a point where this is irreversible, but we have got to start turning this around now. And that's the other part that really disappoints me is I do not see the pushback that should be coming from the players who should be pushing back hard at this moment. No, exactly. And if you think of...

One of the factors that probably underpins what's happening at the moment is Trump's concerns with China.

China's research enterprise is advancing rapidly. I think they're already ahead of the US now in terms of research output. But also the way they've developed their infrastructure, their research capacity, it's incredible. So I think all that's going to happen here is if the US cedes space in research and in science, China will continue to advance. Absolutely.

I think this administration has done an extraordinarily good job at helping China advance its agenda. They claim that they're very anti-China, but everything they've done ... One of the interesting or unfortunate things is, as I've been watching what's been happening in the global health space, as America has withdrawn from WHO, as America has withdrawn from these programs.

Some of it has created a vacuum that no one has filled but a lot of that vacuum is being filled by China Yeah, and and so we are seeding our political soft power to the Chinese It's really kind of mind-boggling for an administration that claims to be want to be tough on China They're actually being very helpful to the Chinese government

In a way that is both really destructive for global public health, but also really destructive for the US soft power Yeah, when you let's go back to the pandemic. I mean you you advise Biden When you see what's happening in the White House now, yes, since the policymaking. Yes. Can you make any sense of it? I can so here's what's interesting and and I will give you a complexity that I think is important for people to understand the Trump coalition is

in 2016, 2017, when he first became president, was made up of two groups of people. Traditional Republicans, people with whom I have, I would say, relatively similar set of values, so maybe differences in strategy. And then the MAGA types, who were much more interested in kind of breaking institutions. But in the first Trump administration, it was probably 80% traditional Republicans, 20% MAGA. That's changed now.

In the current Trump White House, it's probably closer to 50-50 or maybe 60-40 MAGA. So you still have a group of people in the Trump White House who are traditional Republicans or conservatives. They believe in soft and hard power. They believe in American engagement in the world. And they are there. They're in the decision-making space. But they're now increasingly in the minority. Not just the minority. They're not even speaking up.

Well, they're speaking up often through back channels because if they're in the room in the White House, they are having a voice. And you can see this in some of the decisions that are coming out. But because they're in the minority, they're not getting... So give us an example. Where do you see that moderation? Well, moderation may be a strong concept here. But, you know, look, even... Okay, so let's talk about on the health front.

They have named somebody to run the new pandemic office. We stood up a pandemic office in the Biden White House. It was legislated by Congress. They have named somebody into that office named Jerry Parker. Jerry is terrific. He is a traditional Republican. I assume, I don't even know what his politics are, but my sense is he's conservative.

He's a veterinarian. He has been a very prominent player in the One Health space, in the global public health space. Naming him, I thought, was a really, really smart choice. He's not MAGA. Now, the question is, how much influence and power is he going to have?

But if there is, you know, however, whatever happens with bird flu, if there is another major public health challenge in the U.S., Jerry will be the point person in the White House running that. Yeah. But just to counter that, the U.S. has withdrawn from the pandemic treaty, as far as I understand. And also, haven't they stopped discussions about a bird flu vaccine as well? Well, the bird flu vaccine is still up in the air. But no, look, my point here is,

Is it's not a monolithic group and actually once you get into HHS the Health and Human Services Department It gets even more complicated because it's not just traditional Republicans and the traditional our them and the MAGA types But now you have a lot of people who are from the RFK world Yeah, and they're not MAGA and they're not traditional Republicans. They're actually come from a pretty far left

worldview of pharma's bad, all for-profit companies are bad, and again, we have to get back to that. Sounds like the BMJ. No. BMJ, well, you and I both know, and I know you, is that there are problems with the pharmaceutical industry, but the pharmaceutical industry also makes the drugs and vaccines that save lives. It does. We can talk about pricing. We can talk about advertising. We can talk about how they influence practices. Those are all important questions.

But I think it is hard to argue against the fact that pharmaceutical industries products are things we all love and rely on. That help us on a day to day basis. That help us on a day to day basis. It doesn't mean every product does. No. And there are some practices that we're all concerned about. And we should be concerned about those. And we should push back. But there's a difference between saying...

"Pharma is valuable, I want it to be better and has practices that I don't like," versus "Pharma is evil and we should destroy the pharmaceutical industry." - It's like a lot of things, it's a very binary world, isn't it? - Yes, exactly. - Pharma is bad, natural remedies are good. - Exactly. - Vaccination is bad, cod liver oil is good. - Exactly. That kind of very simplistic thinking, there is a whole strand of that inside HHS. So what I would say to your kind of listeners

And this will be important as you watch the Trump administration evolve in the upcoming weeks, months, and years, is that it is not a monolithic group. It is not made up of a coalition of people who all think similarly. Yeah. As interesting as most people here would think it is that. And that's because whoever wins tends to be the face of it. The other part is right now kind of the MAGA kind of destroy everything group is in ascendancy. They have the majority of the power. Hmm.

That, I suspect and believe, will change over time. And I can tell you why I think it will. Yeah, it did. But I do think that that will change. But they can do a lot of destruction. Right now, the problem is there are no checks or balances. Congress is scared to speak up. I've spent a lot of time up on the Hill talking to Republicans in Congress, very reasonable Republicans. And many of them are watching what Trump is doing with

horror, but they're not saying anything. So you're like, well, why aren't they saying anything? Because they want to get reelected in two years. And right now the politics are such that if you speak up against the Trump administration as a Republican, you will face a primary challenge. And if you lose that primary challenge, you're going to be out of a job. So they justify this to themselves as I'm going to stay quiet because I can maybe do more on the inside and

So what why do you think it will change that I think what will change is one advantage that So no one has ever accused Donald Trump of being excessively disciplined. This is a man who

Takes one idea for which there might even be broad consensus, like we should reduce the number of illegal crossings at the border and and does things that are incredibly radical, like stopping permanent residents from coming back to the United States because they might have had a negative tweet about the Trump administration. Right. So deporting children without legal representation. Exactly. I mean, so he does these horrible things.

And majority of Americans who voted for him, voted for stop the illegal immigration at the border, did not vote for deport children. And so slowly but surely, you can see his popularity starting to fall. And as it falls further, the political calculus for members of Congress begins to change. And so, again, I'm not a political analyst and I don't, you know, that's not where I feel like my strength is. But I will say that I do expect in the next three to six months that

A bunch of Republicans starting to speak up because they will realize that staying with the Trump team is going to cost them the general election. And as that happens, his power does begin to diminish if the courts can hang in there. So he's now attacking the courts. It, you know, are attacking all the pillars of democracy. Correct. And the question is, will it survive or not?

I'm like cautiously hopeful it will, but it's going to be a close call. It's not going to be totally straightforward. Um,

But you do have people inside the White House, inside HHS, who are smart, reasonable, thoughtful people whose voices are being drawn out. I will say one last thing, which is in any administration, there are always multiple factions. When I was in the Biden White House on our COVID policies, it wasn't like we were all in unison. We had substantial disagreements inside the White House across the agencies. In fact, a large part of my job was to try to get to enough consensus that we could actually move the policy world forward.

Right now, the MAGA team really is in ascendancy, but you do have smart, reasonable people there. And I feel like part of, like me, our job is to support them in the background so that they can have more voice and ultimately may have more influence. Yeah. I mean, some of these people are working on Trump or rely on Trump. The senators who want to get reelected, for example. Yes. And his team and his staff, you know, they're working for him. Yeah.

Even when other prime ministers go and visit Trump or presidents go they're not critical of him are they no it must be very hard if you're in a position where you know your power what your job and your role depends on his power yes, and one of the things that I have been disappointed by is I have not seen civil society institutions, what do I mean certainly religious institutions

universities push back. Universities right now are... But how can they? I mean, what he's doing in the US with Columbia and other places? Well, so, you know, there are problems at universities. I will tell you, and this is obviously just my own personal opinion, I think universities have done a pretty bad job of managing some real problems around anti-Semitism on campus. It is a real problem.

intellectual diversity on campus. There isn't much intellectual diversity. I would argue that at a place like Harvard or Yale or Brown, probably 95, 98% of people

faculty voted for Kamala Harris. Having institutions that have very little kind of reflection or of the broader American public sentiment is a problem. We are not ideologically diverse. The last thing, especially the elite universities, I think have done a lousy job of reaching out and engaging the middle class. A large majority of their students come from upper middle and really upper class, very wealthy kids.

And so universities... So is that because of the affordability? Well, it is partly affordability. Part of it is strategy of... You know, it's easier to get kids from wealthy high schools and wealthy communities, right? And they'll do well. And they'll do well. And then they will go on and get great jobs and they'll donate back to the university.

So this whole model is deeply flawed. I think one of the reasons universities like wealthy kids is because wealthy kids have wealthy parents who then donate as well. The entire mechanism of trying to raise money

has meant that, but they do have some ideological goals of diversity. So what they then tend to do is supplement that with a small number of kids from kind of lower middle class or lower class. I just mean that financially more poor children.

But that leaves the broad middle out. So kids of teachers and police officers and firefighters. They're caught in between. Actually, it's not only in the US. It's in many other countries. And so you would not be surprised if those parents don't have a lot of sympathy for universities. So what I have said. But do you think that isn't what's driving him? That's not driving trial. But it does create a political problem for universities to push back because they don't have a lot of sympathetic parents.

people in the community. No, Trump is not doing it for that. I mean, Trump doesn't care about this. Trump is doing it because he wants to destroy these institutions. But what I have been arguing really for years and more vocally for the last few months is that the agenda for universities right now is fix your antisemitism problem. It's a real problem. Make a real commitment to intellectual diversity and make a real commitment to the American middle class and demonstrate that.

Okay, so that's what you got to fix. Fight back on academic freedom. Fight back on science. Like, look, the scientific enterprise of NIH, American universities, academic medical centers has been a huge boon to the American people and to the people around the world. It's been a fantastic driver of economic growth, scientific growth.

Universities should be speaking up about that. And when Trump's people go and cut grants, we should be fighting back on that. But we do not have the political credibility to do that if we're not addressing our own issues. So I'm not suggesting we address our own issues for the next two years and then fight back. You got to do both at the same time. But universities are not willing to do the first, and therefore they know they have no credibility on the second.

And that is what worries me. And that's why universities are being quiet. I'll make one other point on this, Karan. Universities have this mindset, and a lot of people in the scientific enterprise do, that this is somehow just kind of a rainy day and we have to get through it. This is not a rainy day. Like, this is climate change. Like, the world is changing in very substantial ways that even if...

Two years from now, Democrats win one of the houses, the house, let's say, and slow down the Trump agenda. He can do so much damage that as we started with, there's no going back to, oh, quickly reversing all of this. So universities actually do have to speak up at this moment, but they have to be thoughtful about where they can speak up and where they're going to have credibility.

It seems like, I mean, you talked about the balance to this of widening diversity and access and opportunity.

is academic freedom science and they're the exact areas that are being curtailed at the moment. So, I mean, how are you, Brown, how are you dealing with this? Well, it's complicated. I mean, obviously at Brown and every other university we're seeing grants get cancelled. We're seeing faculty who work on issues that are quote-unquote controversial like

And these should not be controversial, like HIV prevention. No. We should be preventing HIV. Like, that's just a good thing. Are wondering, do they have to rewrite their grants? We have faculty who work on the health effects of climate change, and they're asking themselves, can I use the word climate in my grant? Maybe I should. Maybe I should talk about extreme heat and other things. Hmm.

So that kind of self-censorship. Yeah, I mean, that's probably, I'm looking from the outside, that's deeply problematic. It's deeply problematic. And I think we should be fighting back on those things. How can you though? Well, I think universities should be speaking up. I think you should be, look, we've got to build a coalition of universities and academic medical centers, but also religious institutions, other civil society organizations. Like we have got to build a whole of society response to this that says like,

Like, it's really important for us to be citing these things, not because it funds universities or if we don't, people will lose jobs. That's not the primary issue, is if we don't understand the health effects of climate change,

There will be large communities in America whose health would be demonstrably worse because climate change is real. It's happening and we have to understand the health effects. Right. So we've got to connect those dots and then we've got to build a broad coalition of people to push back on this. What I think of is this incredible new censorship that is developing out of the Trump administration. It's unprecedented in the US. It's unprecedented. I've never seen anything like this. And it is very corrosive.

And one of the things I do say to my Republican friends who say, well, you know, Trump doesn't want to fund things on diversity and equity and climate change. And I said, look, the next president could be a Democratic one who could also decide that he or she doesn't want to fund on the...

The idea that every four years the presidential election decides what the scientific enterprise of America will work on is a terrible idea. It's a terrible idea. And we've never had it. Republicans have never done this. Democrats have never done this. This is unprecedented. It's very bad and we should stop it. Yeah. Well, if you want to want our support and you want to catalyze something, you know, we're here for you. Thank you. Because it seems...

I mean, again, looking from the outside, you know, you can't talk about climate, you can't talk about equity, you can't talk about reproductive health. These are some of the major challenges that we face in the world today. Correct. And you can't talk about mRNA vaccines now. So, yeah, so mRNA is now, NIH is saying they're going to deprioritize any research on mRNA as a platform.

This isn't putting America first. Well, this is not. I mean, if you think, what's America? It's the people, the well-being of the people. Yeah. Should be that, but it's not that. No, look, first of all, there is, that stuff is really in many ways coming out of, I mean, the mRNA stuff is a lot of that is coming out of RFK Jr. and that view that like, yeah.

you know, we just have to get back to nature. We have to go back to 1900 when everybody lived till 100 and kids never died and everybody was healthy and there was no obesity.

So there is sort of the anti-modern medicine movement that I think has taken hold. It depends a little bit on your vision of America. I mean, my vision of America has always been a very expansive vision of a country where its greatness comes from its innovation, its ability to solve complicated problems, and its generosity to the world. I mean, America has been by far the biggest funder of global public health since

partly because we think it improves our soft power, but partly because just the American people think it's the right thing to do. When PEPFAR, the President's Emergency Program for AIDS Relief, was created under President Bush, yeah, there were people who thought, well, this would be good for American soft power. But that wasn't the major motivation. It was, we want to save millions of lives on the African continent. And we have. So that is a vision of America that I still think a lot of people hold.

We have got to make sure that that vision of America wins out. I was speaking to somebody who I respect a lot, who is American. I was speaking to them last week, and the conversation was, how do you explain the phenomenon? You know, what's going on here? And it was a very compelling argument around, well, it isn't that hard to understand that Trump would get elected because a lot of Americans have got it bad at the moment. And...

I mean, yeah, fine, we accept that. The response isn't one that you'd think is the right one, even though that's the situation. And getting it bad in health, I mean, it's not a new story. The US spends more of its GDP on health than any other major nation, and its outcomes are pretty poor. And so there is something that isn't working there. No doubt. But, yeah, you want to fix that, but it sounds like things are going to get worse.

They are. And there are a couple of other things. If you look at where the federal government invests and where the cutbacks are happening, the communities where life expectancy is lowest, the communities that have the biggest health problems are where you're going to see the biggest withdrawal of US government engagement inside the United States. So I actually think this is going to get much worse. So the vulnerable communities will be... The vulnerable communities are going to be worse. ...as usual. Yeah.

And the truth is that wealthier communities, more educated communities, they'll do fine. They always do fine, even with bad government policies. They'll be better off, probably. Yeah, they'll figure it out. And America has a lot of... America is a complicated country because we have the federal government, but states have a lot of power. Health is largely regulated at the state level. So I think about a state like Massachusetts, where I live, it's got one of the highest life expectancies, actually Massachusetts life expectancy is better than a majority of European countries.

We spent an enormous amount of money in Massachusetts, but Massachusetts will figure this out. Rhode Island will figure it out. Connecticut will figure it out. But Mississippi, which has a very low life expectancy as a state, will struggle further because they actually count on a lot of federal programs that are being cut. So it is very, very unfortunate that the more vulnerable states and communities are the places that are going to see the most amount of suffering.

And, you know, look, people did vote for Donald Trump because they were unhappy with the status quo. There are real problems inside the Democratic Party that need to be fixed. Again, I'm not a political analyst, but I do think Democrats need to fix a bunch of its problems. But nothing I have seen in the last two months of the first two months of the Trump administration makes me think that the things people care about, like high prices, like better health care, like

are actually getting addressed. And in fact, I worry they're all heading in the wrong direction. Let's take one particular example, which is the measles outbreak in Texas and in other states. Yes. The facts are that it's probably worse than it's ever been. And it's people who aren't being vaccinated and vaccination rates are dropping in the US. They are. It's hard to see Robert F. Kennedy Jr. improving that. Well, no. And in fact, everything he's done in his time as health secretary has made it worse. Yes.

Look, there has been an anti-vaccine movement inside the United States for some time. It got a lot more powerful during the pandemic. Robert F. Kennedy Jr. was actually at the forefront, the chief...

kind of leader of the anti-vaccine movement. He claims he's not anti-vaccine. He just has never seen a vaccine that he thinks is any good. But other than that, but he's ready, he's open. He has said, I'm ready for the, if you can show me a single study that shows that vaccines are safe. - There's quite a few. I mean, what is safe though? I mean, every drug, every intervention has a side effect. It has a harm and it's a balance. - It's a balance, exactly. I mean, aspirin is not safe.

You know, there's nothing that safe. Drinking water is not safe, but we still encourage it because on balance, better to be hydrated than dehydrated. But you can drink too much of it and get into trouble. I don't want to push this analogy too far. But the point is,

that the measles outbreak, we have already surpassed the number of cases we had last year and we're still only in March. And there are these attempts at narratives like, oh, the measles outbreak is from all the illegal immigrants. No, we do import measles cases from other countries, but usually when you have high vaccination rates, they don't go anywhere. You have one person comes in and then that person isn't able to spread it in a community that's highly vaccinated.

We are now seeing more and more counties, states where vaccination rates have gotten quite low. And as you know, Kamran, measles, probably the most contagious virus that causes human disease. You need vaccination rates or immunity rates above 95%, certainly above 90% for it not to spread. - This is getting back to the early 19th century. - Yeah. And we have communities, we have counties in America with 40, 50% vaccination rates.

We have states with 70, Idaho at 77% vaccination rate. But that's not enough. That is not enough. So you're going to have larger and larger outbreaks in a lot of places. And as you and I both know, that will mean you'll have kids who get very sick, kids with encephalitis, and unfortunately, kids who are going to die. Yeah. And what Robert F. Kennedy Jr. is doing is distracting us.

While he will say, sure, vaccines, you should consider it. But then he starts talking about cod liver oil and vitamin A and steroids. And if you think about why is he doing this, it's because he's trying to create a narrative that at the end of the day, it's not a big deal if you get measles because we have all these treatments. But we all know cod liver oil is not a treatment. I mean, again, it was a very good treatment in 1932.

Well, not a good one, but it was better than not having a treatment. I mean, it lowered mortality by 50%, which is quite impressive. But without it, mortality was 8% and it lowered it to 4%. So, you know, but 4% mortality for measles is horrible. That's going to be a lot of dead American kids. Yeah, that's from the 1930s. No, but even now. Yeah, I think we're going to see, we've had one child die already and you're going to see more. I mean, how bad do you think it's going to have to get before...

they wake up to this? We're in for a while. We're in for a slog for a while. I don't see this turning around anytime soon. And there are two groups of people here, Kamran, that really... I mean, there is the anti-vaccine group who exploits every opportunity to spread anti-vaccine information. But to me, the much more disturbing are physicians and physician scientists who, for a variety of reasons, hold a lot of grievances from the pandemic.

and have kind of gone all in on the Robert Kennedy Maha movement. And basically will say things like, "Oh sure, Robert F. Kennedy may be wrong about vaccines, but you were wrong about COVID vaccines." And therefore,

"We shouldn't listen to any of this stuff." And I'm like, "Whoa, whoa, whoa, whoa, whoa." Like, okay, we can debate who the right approach to COVID vaccines was and whether children should have gotten them. I believe they should have. Other smart people think they should not have. That's a debate. We can have that discussion. But to say that there was... So there is a whole group of people at reputable universities who I think are fueling this anti-vaccine stuff.

because they hold a lot of personal resentment about how the COVID pandemic played out and are using that to drive this wedge and undermine confidence in the scientific enterprise.

It's very disturbing and it's very disappointing. When it became a sort of intellectual rivalry and people, as we know, tend not to back down or change their view. Yeah. I mean, you should do if the evidence changes or the arguments change. I mean, some people do, but I think too few people do that. One of the things I have said is that people talk about like, you know, who was really reliable in the pandemic and who was not. And I said, look, one of the things I believe is the pandemic was hard. It was complicated. You and I both would agree that

that our understanding, the scientific consensus, all of that changed quite a bit over the period of two, three years that the pandemic was a major force. And I don't know a single person who got everything right.

And I have publicly talked about my own mistakes, advice I gave that turned out not to be right. Some of it was not. It was just based on the evidence that it was at the time. Some of it was a judgment call that I have gone back and said, that was probably the wrong judgment call. What are those examples? Well, I'll give you a couple. I mean, one is the vaccine mandates.

And just being very intellectually honest here, in the spring of 2021, I was very pro vaccine mandates. I thought there should be vaccine mandates in hospitals. I thought there should be vaccine mandates in other settings. And I said as much and I wrote as much. And I will tell you that there are two things. One is I think there was very good evidence at the time that in the short run, vaccine mandates increased vaccinations and probably did save lives.

But in the long run, I have worried that they fueled a distrust of the system that is very costly. And if I had to go back over again, I probably would not have made the same decision.

I think that's right. There's a short-term win, but actually in the long-term, you erode trust and confidence. No one likes being forced to take any treatment. And the history of public health mandates is not a glorious history, and we should lean on mandates very rarely. Very rarely. And...

I was probably, and I have said this, I was probably too cautious about schools opening in the summer of 2020, though I will say by the end of September of 2020, when some schools had opened and we weren't seeing large outbreaks, I switched. I'm on the public record in early October talking about how we need to open up all the schools.

But you could say, hey, for that one month, you were more cautious than you should have been. Probably true. Probably true. What made you switch? Data. It turned out. So I was in the summer of 2020. I wrote op-eds. I was on the record saying, look, if we open schools without any mitigation, you're going to see large outbreaks in schools and you're going to see lots of kids get sick and you're going to see teachers get sick.

And a bunch of states kept schools closed in September of 2020, and a bunch of states opened schools. So Rhode Island opened all its schools. Florida and Georgia opened all its schools. And then I started looking at the data in the first four weeks of schools being open, and there weren't major outbreaks as a result.

And so my response was, I had a hypothesis. I now have data. And the data suggests that my hypothesis was probably wrong. And we know there's a cost to keeping schools closed. I could see that in my own state. And so I switched because I feel like my job is to look at the latest evidence and give you my best advice. And...

And, you know, it went from I was sort of a darling of the of the people who wanted to keep schools closed. So I became the enemy. And people are like me. You were paid off by the Koch brothers. I'm like, what? No, I don't take any money from the Koch brothers. And I don't take money. I take money from my university for my job. But other than that, but no, like I saw the data and I could point to the data. So, yeah.

There was a lot of kind of the sense that you had to be intellectually consistent. I'm like, intellectually consistent is being intellectually honest to the evidence, not sticking to whatever advice you gave on day one.

My view. It's a different way of thinking about intellectual consistency. Okay. Yeah. I think that was very good of you to switch on the basis of data. In another example of data, we do have data on whether or not MMR vaccination causes autism. We have overwhelmingly clear data.

Yeah, this is not one where we... Apparently, we don't have any dates, so we need a new research. Well, so this is a distraction, right? This is a distraction because obviously you and I both know that the evidence here is incontrovertible, very, very clear. Actually, there are very few things in science that are so well settled as this one. So it's nice to have one. And then to question that is kind of interesting. But his whole thing of we need to do a new study is not because there's an actually intellectually curious question around do vaccines cause autism.

It now allows RFK to spend the next months or even years saying, hey,

We don't know if vaccines cause autism. We're studying it. You got to give it some time. I'm not going to make a recommendation until the date are in. So I don't need to push MMR vaccination because we don't know whether it works. Because we don't know if it works. It might cause autism. Exactly. And we're doing those studies right now. So just hold on. Which is a false argument. It's totally false. He knows that these things are very safe.

Does he though? I mean, he seems so convinced of his own views. I mean, look, who knows what he actually knows? What I do know is that he got all of his own kids vaccinated. Yeah, he did. So there's a little bit of voting with your feet, right? I mean, during the pandemic, whenever I talked about advice, I always said, let me tell you what I'm doing with my own family.

as a way to say, like, I can say whatever I want, but how do I behave with my own families? What I actually think. That's what you really, yeah. That's what you think others should be doing as well. She's fine. Thank you. You're very generous with your time. When we look in at the US from the outside, obviously we're all feeling the effects of events in the US. But people want some kind of hope that things are going to turn around. You've offered some of that, albeit a little guardedly.

What is the hope? I mean, can we resist assault on science and research and population health and well-being? Look, throughout human history, there have been multiple forces that shape society, not just government. If you look through the last 2000 years, there are times when governments are strong. There are times when churches are strong. There are times when civil society organizations are strong.

The way that we need to push back on some of the most egregious things coming out of the Trump administration, in my view, is we need to make the case for these things to the American people. You need to make the case for why investing in science actually leads to improvements in health.

We need to make the case that universities actually do good for society. I think a majority of Americans no longer believe that universities are a force for good. That's a huge loss of faith and a huge loss of confidence. So I don't think this is just about marching on the streets and pushing back on everything. I don't think that's going to work.

I think we have to do a two-pronged approach of fix the problems that are real, but at the same time, make the case for the things that really matter. And if the American public sees us doing both, fixing the things that they think are broken,

but at the same time making the case for things that matter. I actually do think you're going to get a lot of Americans behind you. And when you do, you're going to get Congress more behind you. And when you do, you start putting real guardrails around what the Trump administration can do. Until we do our job in the civil society realm of things, and private sector companies have to do this. I do think religious leaders need to do this. If we can marshal those forces, we absolutely can prevent a lot of this loss and get to a better place.

Okay, well, we'll cling on to those hopes, Sheesh, and I'm going to go and search the bmj.com archives for cod liver oil. Cod liver oil. Apologies to the population of America for any dodgy science that's now, policy that's arising from that. I mean, I think it was cutting edge science in 1932. And, you know, what better place to publish it in BMJ? Who would have thought? I'm sure that whoever the editor in chief at that time was, I probably did not believe that.

that 100 years later, a health secretary of America would be relying on that study to push treatments for measles. Well, every editor wishes for that kind of paper, but not to mislead the popular people of the future. Ashish, thank you very much for your time. Kamran, it's been a pleasure. Thank you for having me here. Thank you.